RESEARCH PROJECT 2: Project Summary/Abstract Although 20% of US children have a diagnosable mental health (MH) disorder, and 3-18% of them have a MH disorder serious enough to result in significant functional impairment, fewer than 50% receive treatment. There are many reasons for the lack of treatment, not the least of which is the failure of the systems that most often interact with them (educational and medical care) to identify MH disorders; this is of concern, given the increase in youth presenting to Emergency Departments (EDs) with MH disorders. The availability of a new screening instrument, the Y-CAT (screens for six MH disorders, has a suicide scale providing both dimensional severity measures and diagnoses, and disposition protocol), provides a quick, simple way to greatly improve the diagnosis and management of youth MH disorders in EDs. Specific aims of the proposed study are to: Aim 1: Screen, using the Y-CAT dimensional severity measure and the associated diagnostic screener (both now called Y-CAT), all consenting youth 7-18 with non-life threatening problems and their legal guardians visiting two New York University (NYU) Pediatric EDs (Tisch and Bellevue) and the NYU-Bellevue Children's Comprehensive Psychiatric Emergency Program (CCPEP) during three randomly assigned three-month periods and compare results from the Y-CAT to the diagnoses and treatment recommendations of ED physicians. For families who do not agree to complete the screening instrument, ask reasons for refusal to participate. Identify, using CCPEP data, reasons for Y-CAT-child psychiatrist discrepancies; Aim 2: Educate, using the data from Aim 1, the Tisch, Bellevue, and CCPEP staffs after their assigned screening period on the amount of under diagnosis and treatment of youth MH disorders, the conceptualization, structure, and psychometric properties of the Y-CAT. For one randomly assigned pediatric ED we will also provide a disposition protocol based on the severity of diagnosis generated by the Y-CAT. Assess, prior to each educational session, the level of confidence of the ED physicians in their ability to diagnose and manage youth SMHD; Aim 3: Assess the impact of Y-CAT Feedback only vs. Y-CAT Feedback plus Disposition Protocol on physicians' behavior. Compare a second set of screens using the Y-CAT for youth 7-18 visiting the three EDs in the three months immediately post that ED's education session and feedback the results from the Y-CAT (and disposition in one ED) to the treating physician. Compare results from the Y-CAT to the diagnosis and treatment of ED physicians with and without the disposition intervention. We will also examine if ED physicians' confidence mediates physicians' behavior. Assess at the end of the three-month feedback, ED physicians' confidence. Examine whether changes in confidence (pre- and post-intervention) vary with and without the disposition intervention and evaluate the impact of change in confidence on diagnostic agreement; and Aim 4: Document the patient, provider and organizational barriers to the implementation of screening with the Y-CAT and salvage strategies used to overcome barriers.